Abstract

Objectives To evaluate end-of-life care in a cohort of oncology patients in Olmsted County, Minnesota, USA, and compare differences
between patients participating in clinical trials and those not in clinical trials.

Methods A population-based cohort of subjects with active oncological disease who died between 2000 and 2002 was constructed retrospectively
using institutional databases. Clinical trial participation and care during the last 2 months of life were analysed.

Results A total of 395 eligible patients were identified. In the 2 months prior to death, 94 (24%) patients received chemotherapy,
232 (59%) were hospitalised, 249 (63%) were in hospice and 315 (80%) had a do not resuscitate (DNR) code status. Only 8 (2%)
patients received cardiopulmonary resuscitation (CPR) and 26 (7%) patients participated in a clinical trial. Patients in clinical
trials were more likely to receive chemotherapy (69.2% vs 20.6%; p<0.001), undergo intubation/mechanical ventilation (15.4%
vs 5.4%; p=0.040) and less likely to have DNR code status (50.0% vs 81.8%; p<0.001) when compared with patients not in clinical
trials. However, no differences in hospice enrolment, days in hospice, days in the hospital, CPR or location of death were
noted.

Conclusions Although opportunities for improvement exist, high quality end-of-life care was found in this study of patients with active
malignancy. A majority (over 60%) of patients enrolled in hospice prior to death, 80% had a DNR status and only 2% received
CPR. Although clinical trial participants received more aggressive treatments during the last 2 months of life, they did not
appear to have lower quality end-of-life care.